Abstract

Introduction: The management of women with pregnancy complications at the peri-viability period involves a complex set of medical, ethical, emotional, and social challenges for the obstetrician. The survival rate of preterm babies has been improving along with advancement in neonatal intensive care unit (NICU) technology. Our recent experience has shown survival of even very preterm infants with the use of surfactant therapy.Objective: This observational study was conducted in order to evaluate the survival benefit of surfactant therapy on preterm neonates, to enable straight forward decisions to be taken by the obstetricians regarding antenatal steroid prophylaxis, in-utero transfer and mode of delivery in case of inevitable preterm births. Material and Methods: This study was conducted in the NICU of a tertiary hospital over a period of 3 years (2009-2011). We recruited only those preterm neonates who received surfactant therapy and the records were obtained and analyzed. Survival benefits of surfactant therapy, role of antenatal steroids, in utero transfer and mode of delivery were studied. Results: Almost all (98.6%) neonates who did not receive antenatal steroids at all, landed up in respiratory distress syndrome (RDS) requiring surfactant therapy. Among the outborns 59.2% had an extended NICU stay as compared to 49.4% in the inborn group. The overall incidence of RDS was found to be more in caesarean delivery group (96.3%). However if the period of gestation at the time of delivery was less than 28 weeks, caesarean delivery had lesser incidence (12.5%) of RDS compared to vaginal delivery (27.1%). Similar finding was noted when comparing mortality. In less than 28 weeks gestation, when caesarean was done 2.5% newborn babies died, whereas in the vaginal delivery group 12.5% babies succumbed to death.Conclusion: 1) Even in centers with facilities of surfactant therapy, steroids prophylaxis should be considered before delivery 2) Obstetricians should practice in utero transfer, to centers with NICU, having availability and technical expertise of surfactant prophylaxis 3) With the availability and wide spread usage of surfactant for premature neonates caesarean delivery should not be deferred for fetal benefit.